Smile Design 2 White - 5th District Dental Society · Esthetics in Dentistry. 2 nd ed. Hamilton, On: BC Decker Inc, 1998: 133-186 Smile Design Principles • Central incisors •

1

“The dentist who wants to create a smile

design must closely observe the intact

smile, the dominant position of the

maxillary central incisors, and the art of

the esthetic integration of the

maxillary incisors in proper proportion to

the face. The patient will exhibit a

pleasing smile only when the quality and

health of the gingival and dental

elements, together with the relation

between teeth and lips, are

harmoniously adapted to the face.”

Gurel G. The Science and Art of

Porcelain Laminate Veneers.

London: Quintessence; 2003

Definition

Components of the Smile

• Teeth

• Gingival Scaffold

• Lip Framework

Garber DA, Salama MA. The aesthetic

smile diagnosis and treatment.

Periodontol 2000 1996; 11:18-28

Classification of Upper

Lip Lines

High

Mediu

m

Low

2

Smile Design Principles

• Central incisors

• Mid-line

• Axial inclinations

• Arch form

• Smile arc

• Gingival height

symmetry and

zenith placement

• Contact points

and Embrasure

form

• Gradation

• Buccal corridors

• Golden

proportion

• Balance and

symmetry


• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and zenith

placement

• Contact points and Embrasure form

• Gradation


• Golden proportion

• Balance and

symmetry

• Ideal

• Acceptable

• Unacceptable (unaesthetic)

Evaluate principles

individually and with

respect to what would be:

Smile Design

Principles

Central Incisors

• Incisal Edge Position

• Individual tooth proportion

Gurel G. The Science and Art of

Porcelain Laminate Veneers. London:

Quintessence; 2003

“The incisal edge of the maxillary

central incisor is the most

important determinant in the

creation of a smile. The position

of the incisal edge acts as the

parameter upon which the rest of

the treatment is built.”

3

Tooth Display at Rest

Vig RG, Brundo GC. The kinetics of

anterior tooth display. J Prosthet

Dent 1978;39:502-504

The Three F’s

• Facial esthetics

• Function

• Fonetics (phonetics)

Evaluation of Intra-oral

Mock-ups and Provisional

Restorations

T-Scan

4

Individual Tooth Proportion

Shillingburg Jr HT, Kaplan MJ, Grace CS. Tooth dimensions. A comparative study. J. South Calif Dent

Assoc 1972; 40: 830

Length to Width Ratio of

Central Incisors

8.5mm

8.5mm8.5mm

11mm

13mm

9mm

65%77%

94%

5

Reasons for Increasing Incisal

Length

Worn incisal edges

Inadequate tooth display

Unesthetic tooth proportions



• Mid-line

Facial Midline

Dental Midline

6

Kokich VO, Kiyak HA, Shapiro PA. The perception of dentists and lay people to altered dental esthetics. J

Esthet Dent 1999; 11: 311-24



• Mid-line


Axial Inclinations

Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J

Prosthet Dent 1973;29:358-382

7

Correcting Axial

Inclinations



• Mid-line


• Arch Form

Arch Form

Ovoid

(U-

Shape)

Tapere

d

(V-

Shape)

Squa

re

8

Direct vs. Indirect Intra-oral

Composite Mock-up Technique



• Mid-line


• Arch Form

• Smile arc

The Smile Arc

Sarver DM. The importance of incisor

positioning in the esthetic smile: the smile

arc. AJODO 2001; 120: 98-111

“The ideal smile arc has the maxillary incisal

edge curvature parallel to the curvature of

the lower lip upon smile.”

9

Flattening of the Smile Arc in

Orthodontically Treated Cases

• Intrusion of maxillary incisors

• Bracket positioning

• Proclination of anterior teeth to

accommodate crowding without

extraction

• Arch expansion to broaden the

smile

Ackerman J, Ackerman MB,

Brensinger CM, Landis JR. A

morphometric analysis of the posed

smile. Clin Orthod Res 1998;1:2-11

Flattening of the Smile Arc in

Non-Treated Cases

• More vertical growth in posterior

maxilla

• Skeletal patterns

• Habits

• Anterior tooth wear



• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and

zenith placement

10

Gingival Height

Symmetry

Zenith Placement

Zenith Placement in Diastema

Closure

Moskowitz M, Nayyar A. Determinants of dental esthetics:

A rationale for smile analysis and treatment. Compend

Contin Educ Dent 1995;16:1164-1186

11

Options for Treating Gingival

Asymmetry

• Gingival recontouring

(gingivectomy)

• Crown lengthening with osseous

surgery

• Orthodontic intrusion or

extrusion

• Gingival graft

Biologic Width

Gargiulo AW, Wentz FM, Orban B. Dimentions and

relations of the dentogingival junction in humans. J

Periodontol 1961;32:261-267

Cohen DW. Periodontal preparation of the mouth for

restorative dentistry. Presented at the Walter Reed Army

Medical Center, Washington, DC, 1962.

Biologic Zone

Kois JC. New paradigms for anterior tooth

preparation: Rationale and technique.

Contemp Esth Dent 1996;2:1-8

12

Excessive Gingival Display

(Gummy Smile)

• Short philtrum height

• Hypermobile lip

• Vertical maxillary excess

• Compensatory eruption

• Anterior dentoalveolar extrusion

• Altered passive eruption

Benefits of a Mock-Up

• Can help determine incisal edge position

• Can help to establish proper arch form

• Can serve as a guide for gingival height

symmetry, tooth proportion, and facial

contours

• Will aid in evaluating aesthetics,

function, and phonetics

• Can be used as a template for

provisionals in the absence of a wax-up

• Can be beneficial for laboratory

communication and patient feedback



• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and

zenith placement

• Contact points

and Embrasure

form

13

Contact Points and Embrasure Form

Intercres

tal bone

Contact

area

Relationship of papilla

height and the distance from

the interdental contact area

to the crestal bone

5mm

Intercres

tal bone

Contact

area

Tarnow DP, Magner AW, Fletcher P. The

effect of the distance from the contact

point to the crest of bone on the

presence or absence of the interproximal

dental papilla. J Periodontol 1992; 63:

995-996

14

Lengthening the interdental

contact area to close dark

triangles

5mm

Goldstein RE. Esthetics in Dentistry. 2nd ed. Hamilton, On: BC Decker Inc, 1998: 133-

186



• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and

zenith placement

• Contact points

and Embrasure

form

• Gradation

Gradation

Renner RP. An Introduction to Dental Anatomy and Esthetics. Chicago:

Quintessence, 1985:125-166, 187-233

15



• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and

zenith placement

• Contact points

and Embrasure

form

• Gradation


Buccal Corridors

Frush JP, Fisher RD. The dynestheticinterpretation of the dentogenic concept. J

Prosthet Dent 1958;8:558-81

Moore T, Southard JSC, Qian F, Southard TE. Buccal corridors and smile esthetics.

Am J Orthod Dentofac Orthop 2005;

127:208-213



• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and

zenith placement

• Contact points

and Embrasure

form

• Gradation


• Golden

proportion

16

Golden Proportion

Lombardi RE. The principles of visual perception and their clinical application to denture esthetics.

J Prosthet Dent 1973; 29: 358-382

Levin EL. Dental esthetics and golden proportion. J Prosthet Dent 1978; 40:244-252

Recurring Esthetic Dental (RED)

Proportion

The proportion of the successive

widths of the teeth as viewed from

the frontal aspect remains constant as

you move distally in the arch. The

dentist may use a proportion of their

choice as long as it remains consistent

while moving distally.

Ward DH. Proportional smile design

using the recurring esthetic dental (red)

proportion. Dent Clin North Am. 2001;

45: 143-154



• Mid-line


• Arch Form

• Smile arc

• Gingival height

symmetry and

zenith placement

• Contact points

and Embrasure

form

• Gradation


• Golden

proportion

• Balance and

symmetry

Documents

Smile Design 2 White - 5th District Dental Society · Esthetics in Dentistry. 2 nd ed. Hamilton, On: BC Decker Inc, 1998: 133-186 Smile Design Principles • Central incisors •